New Student Online Lesson Request Form www.SLOMusicLessons.com

Your Name

Email Address

Phone

What are the best ways to contact you? What are the best ways to contact you? E-mail Phone Call Text

OPTIONAL: Fill in good times to call you

Who will be taking these Lessons? Who will be taking these Lessons? Myself Someone Else

Name of student(s)

Which instruments are you interested in? Which instruments are you interested in? Guitar Violin Ukulele Mandolin Banjo Piano Upright Bass Electric Bass

Do you already have an instrument? Do you already have an instrument? Yes No

Online or In-Person? Online or In-Person? BOTH In-Person and Online Only In-Person Lessons Only Online Lessons

What kind of lesson formats are you interested in? What kind of lesson formats are you interested in? Private 1 on 1 Lessons Private 1 on 1 Lessons AND Group Lessons

What day(s) of the week are you available? What day(s) of the week are you available? Mondays Tuesdays Wednesdays Thursdays Fridays

What time(s) are you available on Monday?

What time(s) are you available on Tuesday?

What time(s) are you available on Wednesday?

What time(s) are you available on Thursday?

What time(s) are you available on Friday?

Briefly describe any previous musical experience

Optional: Briefly describe any specific musical goals

Gift Certificate(s) Gift Certificate(s) I am redeeming a Gift Certificate that was given to me I would like to purchase a Gift Certificate to give these lessons as a gift